ABSTRACT
Aim: to asses an opportunity for predicting an unfavorable perinatal and maternal pregnancy outcome in severe novel coronavirus infection (NCI) COVID-19. Materials and Methods. A retrospective comparative study of the course and outcomes of pregnancies was performed in 40 patients with a gestational age of 22-42 weeks who had severe and extremely severe COVID-19 in 2021. The main group included 21 cases with an extremely severe course of the disease resulting in maternal mortality;the comparison group consisted of 19 patients with severe COVID-19 who successfully completed pregnancy. The diagnosis of NCI COVID-19 was confirmed in all cases by identifying SARS-CoV-2 RNA by polymerase chain reaction in a nasopharyngeal swab. During the study, all patients (during hospitalization, at the peak of the disease and before death/discharge from the hospital) underwent a comprehensive anamnestic, clinical and laboratory-instrumental examination. There were analyzed clinical blood test, biochemical parameters - lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase, creatinine, glucose, total bilirubin, total protein;coagulation parameters - prothrombin level according to Quick and fibrinogen, activated partial thromboplastin time, international normalized ratio;the level of C-reactive protein, procalcitonin, D-dimer, interleukin-6 (IL-6);ultrasound examination was performed during pregnancy (fetometry, placentometry), dopplerometry of uteroplacental blood flow and ultrasound of the pelvic organs, as well as pathomorphological placenta examination. Results. In patients who died from extremely severe NCI COVID-19 (main group), the course of the infection was accompanied by developing of respiratory distress (RD) degree III (chi2 = 12.84;p <= 0.05), and a progressive deterioration in mother's condition and/or fetal distress was an indication for emergency delivery by caesarean section (CS). The course of severe NCI COVID-19 in patients with a favorable outcome (comparison group), as a rule, was accompanied by the development of RD grade I and/or II;most of them were also delivered by CS on an emergency/urgent basis. Predictors of rapid progression of severe NCI COVID-19 in the main group were identified: subfebrile body temperature at the initial stages skewing to high fever during treatment instead of rapid temperature normalization (chi2 = 5.41;p <= 0.05;odds ratio (OR) = 5.0;95 % confidence interval (CI) = 1.23-20.3);lack of leukocytosis at the initial stages (chi2 = 4.91;p <= 0.05;OR = 50;95 % CI = 5.43-460.54) with rapidly increased leukocyte count with persistent stagnation in dynamics until death (chi2 = 19.79, p <= 0.05, OR = 50;95 % CI = 5.43-460.54);severe lymphopenia (chi2 = 8.09;p <= 0.05;OR = 7.29;95 % CI = 1.74-30.56), neutrophilia (chi2 = 10.17;p <= 0.05;OR = 10.29;95 % CI = 2.21-47.84);high LDH values (chi2 = 17.99;p <= 0.05;OR = 31.88;95 % CI = 5.09-199.49);increased IL-6 level at the peak of the disease (chi2 = 9.66;p <= 0.05;OR = 18;95 % CI = 1.99-162.62) and in dynamics, as well as stably high D-dimer values (chi2 = 9.53, p <= 0.05;OR = 11.33;95 % CI = 2.07-62.11). Conclusion. Significant changes observed in clinical and laboratory examination were identified, which reliably reflect the degree of patients' state, to be interpreted as predictors of adverse pregnancy outcomes during NCI COVID-19 and as a potentially justified serious reason for making a decision in the light of timely delivery aimed at a favorable outcome for mother and child. Timely delivery, carried out within the time limits for enabling adequate compensatory capabilities of the pregnant woman's body, demonstrates a rapid normalization of the main laboratory parameters.Copyright © 2023 IRBIS LLC. Pravo. All rights reserved.
ABSTRACT
STATEMENT OF PROBLEM/QUESTION: Given that cervical cancer screening (CCS) rates have declined during the COVID-19 pandemic, and the extent to which logistical barriers contribute to delayed CCS, this quality improvement project aims to improve CCS rates in our clinic through dedicated, convenient clinical sessions for Pap tests. DESCRIPTION OF PROGRAM/INTERVENTION: The UPMC General Internal Medicine-Oakland (GIMO) Clinic held “Pap Days,” clinic sessions dedicated for CCS and conducted by women's health-trained GIM faculty. Eligible patients were those who: 1) see PCPs at GIMO, 2) were eligible for CCS based on age and pelvic organ status (i.e. had not had hysterectomy for benign reasons), and 3) were overdue for CCS. Bulk EMR-generated messaging was used to invite eligible patients to schedule an appointment. PCPs could also directly refer patients. MEASURES OF SUCCESS: We will analyze the administrative burden involved in scheduling the sessions and the return on that investment, e.g. the number of invitations sent, the number of appointments made, and the number of appointments completed. As the goal of CCS is to identify and treat precancerous lesions before they become cancerous, we will quantify the abnormal results that are detected and any recommended follow-up testing. We will also analyze patient characteristics, to guide future Pap Days. FINDINGS TO DATE: 70 appointment slots were scheduled over 4 days in November and December 2021. 1086 patients were contacted through a secure messaging portal. 67 appointments were scheduled for 63 unique patients;38 visits were completed (57%), 5 were no-shows (7.5%), 22 cancelled (33%), 2 were not for CCS (3.3%). 57 of 63 patients (90%) were insured by the health system's affiliated health plan;39 (62%) had employer-sponsored plans, 5 had Affordable Care Act plans (8%), 16 had Medicaid (25%), and 3 had Medicare (5%). 12/63 (19%) patients had no prior CCS records in our EMR. Of the 38 Paps that were performed, 30 (79%) were normal, 2 (5.3%) were ASCUS/ HPV-, 2 (5.3%) were ASCUS/HPV+, and 4 (11%) were unsatisfactory. Evaluation of how long patients were overdue is ongoing. KEY LESSONS FOR DISSEMINATION: This project demonstrates the feasibility and success of a quality improvement intervention-dedicated CCS sessions-to improve rates of CCS. Recruiting patients and scheduling appointments was relatively easy to implement, and anecdotal feedback from the patients and physicians was very positive. We recruited a wide array of patients from our clinic panel. Challenges were encountered because our EMR often defaults to 3-year CCS intervals and requires that providers manually update the interval to 5 years where appropriate, so outreach lists included patients who were wrongly identified as overdue. Nevertheless, the results of this program suggest that it is scalable to more patients and would be easy to implement in outpatient clinics of any size and geographical area.
ABSTRACT
Relevance: Despite the widespread use of COVID-19 vaccination worldwide, the number of studies on the impact of various types of vaccines on women’s reproductive health is limited in the scientific literature. The preliminary results of the study on the negative effect of vaccination with the Russian Gam-COVID-Vac vaccine on the ovarian reserve and the level of antiphospholipid antibodies in reproductive-aged women were first published in 2021. Objective: To evaluate the effect of the Russian combined vector vaccine against the novel coronavirus infection caused by SARS-CoV-2 on the parameters of ovarian reserve and menstrual function in reproductive-aged women. Materials and methods: A prospective interventional study included 220 women vaccinated with a combined vector vaccine Gam-COVID-Vac for the prevention of a novel coronavirus infection caused by SARS-CoV-2. The inclusion criteria were age from 18 to 45, preserved menstrual function, no history of COVID-19, negative PCR test result for SARS-CoV-2 and negative SARS-CoV-2 IgG antibody test before vaccination, no pregnancy, and no history of serious illnesses. The patients were examined twice: immediately before vaccination and 90 days after the first dose was injected. Antral follicle count was determined during the ultrasound examination of the pelvic organs. Serum levels of AMH, FSH, estradiol on the 2nd–5th day of the menstrual cycle, as well as IgG antibodies to SARS-CoV-2 were measured using enzyme immunoassay. Results: The efficacy and safety of the Russian combined vector vaccine against COVID-19 was high. The humoral immune response (specific IgG to SARS-CoV-2) was detected in 98.6% of vaccinated patients. There were no cases of severe side effects after vaccination. There were no significant changes in the hormone levels, antral follicle counts and menstrual function before and after vaccination;women of advanced reproductive age (©37 years) did not show considerable changes either. Conclusion: The results of the study indicate that vaccination with a combined vector vaccine Gam-COVID-Vac against a novel coronavirus infection caused by SARS-CoV-2 is effective and safe;it does not have a negative effect on ovarian reserve and menstrual function in reproductive-aged women.